Surgical choices when diagnosed with breast cancer

January 31, 2012 2:43:57 PM PST
Over 230-thousand women will hear a diagnosis of breast cancer this year.

Removing the tumor is almost always part of the treatment, but how the tumor is removed can determine if a woman needs more surgeries.

A new study today found second surgeries are sometimes done, but there is great variation in a woman's chances of needing them.

The choices for surgery can involve removal of the just the tumor, called a lumpectomy. The surgery can also be a partial mastectomy, or a total mastectomy, which is complete removal of the breast.

Not one surgery is best for all women, but many women choose to preserve their breasts with either a lumpectomy or a partial mastectomy. As today's study shows, that too carries its risk which can be heightened by the choice of surgeon and hospital.

Reality star and TV host Giuliana Rancic is the latest celebrity to face the challenge of a breast cancer diagnosis.

After doctors failed to remove all the cancer with a double lumpectomy, she opted for a double mastectomy, which is complete removal of both breasts.

Comedienne Christina Applegate also chose a double mastectomy, after having a lumpectomy, but then discovering she carried a breast cancer gene.

Some women choose mastectomy because they fear cancer will be left behind with the lesser surgeries.

According to today's study, as many as one in four women do not achieve "clear margins" when their tumor is removed with a partial mastectomy.

"The goal of the surgeon is to excise the cancer with just a little bit, a small rim of normal tissue around the cancer and that's called your margin," Dr. Laurence E. McCahill of St. Mary's Health Care said.

If the margin isn't clear, it's back to the operation room.

After studying 22 hundred women in 4 health systems, dr. Laurence McCahill found that one in four had to go back for a re-exision, a second surgery, after having had a partial mastectomy.

The study found a wide range in the rates. Among surgeons, re-excision ranged from zero percent to 7o percent. Some surgeons never did second surgeries, and some did them in 7 out of 10 patients.

"The range of re-excisions do not appear to be completely explained by the patient or tumor characteristics," McCahill said. "Just randomly selecting two surgeons in the study having the same clinical factors, the same tumor size, the same tumor characteristics by seeing a different surgeon you were 60 percent more likely to undergo a second operation."

The study is published in tomorrow's Journal of the American Medical Association.

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